HomeMy WebLinkAbout361 22ND ST - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.g�LDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 367 22ND ST
Suite:
Viciniry: GAME ROOM
Primary Occ: R1
Parcel Number: 42617117
Applicant: MITCHELL, STEPHEN H TR
Address: 361 22ND ST
COSTA MESA, CA
Owner: MITCHELL, STEPHEN H TR
Address 361 22ND ST
COSTA MESA, CA
Contracto r: O W N E R-B U I LD E R
Address:
Zip:
Arch : TEALE, MARK
Address: 2900 BRISTOLSTREET
SUITE A203
COSTA MESA, CA
Zip: 92626 •
Type of Consiruction: V-N
2oning:
Phone: 949-975-0123
License: C22162
Phone: 949-548-9294
. Zip: 92627-1800
Phone: 949-548-9294 �
Zip: 92627-1800 '
Phone:
License: 000000
Eng: Sid�CR
Address: 112�£�CH�
SU1TE #D
ORANGE,
92866
StaWs: ISSUED
Applied: 10/17/2006
Issued: 10/17/2006
BY:
�R�}I `�
YI ��
.„xi;,...",C
._ I''
:,.".
�, ' "y
� �.
�[}a;t
�,
Phone:� �774-997-9120
License: 43205
SCOPE OF PERMIT
INTERIOR REMODEL OF AN (E) DETACHED GAME ROOM . WORK TO INCLUDE: REMOVAL OF INTERIOR LOAD BEARING WALLS AND REPLACf
W/STRUCTURAL SUPPORT BEAM AND CHANGE OUT OF 12 WINDOWS, 1 SET OF EXTERIOR FRENCH DOORS AND 1 SINGLE EXTERIOR DOOF
FOR LIKE. NO
CHANGE IN HEADER OR SIZE. WINDOWS MUST COMPLY W/1997 UBC EGRESS REQUIREMENTS.
Plan Check: $208.81
Permit: $321.25
SMIP Res: $2.00
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $532.06
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Front 0-0
PARKING Existina: o
Rear 0- 0
Rear 0- 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Lefl 0- 0
Reauired: 0 Pr000sed: 0
Calc Valuation:
Claim Valuation
Right 0-0
Right 0-0
s2o,000.00
$zo,000.00
NOTICE: The work authorized by this parmit shall comply with all applicable handicap access requirements undar California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 1 BO days.
INSPECTIONS: In order tor ihe work authorized under this permit to be consitleretl legal, such work must comply with all applicable codes, and all
required Inapectlona and final approval must be obtainetl. Failure to obtain inspections and final approval will result in the ezpiration of this permit.
IFOR INSPECTIONS CALL: (714) 7545626
zanuae lrvoo)
`
,
WORKERS' COMPENSATION DECLARATION: � \
I hereby eNirm under penalry ot perjury one of the following declarations:
❑ I hava entl wlll meintein a certificate ol consent to self-Insure tor workers' compensetion, as provitled for by section 3700 ot tha Lebor Code, for ihe pedortnence of ihe
work lar which thls permit is issued.
❑ I have and will maintain workers' compensation insurance, as required by section 3700 of the Lebor Code, for Ne perfortnance oi Ne work for which this permit is issuad.
My workers' wmpensatlon Insurence cartiar and policy number are:
Cartier: PoliCy Number:
(This sectlon neetl not be comple(ed i! the permit is velued af one hundred dollars ($100) or Iess.J
�- I certily Ihet In Ihe performance of the work for which this pertnit is issuetl, I shall not employ any person in eny manner so es to become subject to Ihe workers'
compenselion lavis of Califomia, entl egree Ihet if I shoultl become subject to the workers' compensation provisions ol Sectio 3700 oi,1he Labor Cotle, I shall fonhwith
�comply with these pr —' � �� � /��j
Applicen� Signetu j�e Date: ���
�WAflNING:-FNWRE TO SECU E WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINA� PENALTIES AND CIVIL FINES UP TOONE HUNORED
THOUSAND OOLLARE (5100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVI�ED FOP IN SEGTION 3106 OF THE LABOF CODE, INiEREST, AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby attirm ihat I em licensed under provlsions of Chapter 9(commencing with Section 7000) ot Division 3 of the Business and Professions Code, and my license is in full
torce end eNecf. Lic.11 Class #
Contractor5 Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby ettirm ihat there is a consiruction lending egency for the peAormance of ihe work for which ihis pertnit is issuad. (Sec. 3097, Civil Code).
Lentlels Neme: Lendefs Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby eXirm Ihat under penelry of perjury �ha� 1 am E%EMP7 FROM THE CONTRACTORS LICENSE LAW for �he following reason (Sec. 7031.5, Business and Protesslons
Cotle: Any city or counry which requires e permit to consimct, elter, improve, demolish, or repair any slmcture, prior to its issuance, also requires the applicant tor such permit
to file e signed statement ihet he or she is licensed pursuent to the provisions ot the Contracrors License Lew (Chapter 9(commencing with Section 7000) of Division 3 oi Ne
Business end Professions Code) or that he or she is enempt therefrom and the basis for the alleged exemption. Any violetion ot Section 7031.5 by eny apPlicant tor e permit
subjects the applicant to a civil penelty c� not more ihan five hundred dollars ($5�0).):
(�I, as owner ot the property, or my employees with wagas as ihelr sole compensation, WILL DO 7HE WORK, and Ihe siructure is not intended or otteretl for sale (Sec.
� 1 7044, eusiness and Professions Code: The Contractors License Law dces not apply to an owner of properry who builds or improves ihereon, and who does such work
himsetl or herseH or through his or her own employees, providetl ihet such Impmvements ere not Intendetl or oNeretl for sale. N, however, tha building or improvement is
sold wilhin one year ot completion, the owner-builtler will have the burden of proving thal he or she ditl not build or improve for puryosa of sale.). '
❑ I, es owner oi ihe property, am EXCWSIVELV CONTRACTNG WITH LICENSED CONTRACTOHS ro construct the project (Sec. 7044, Business and Professions
Cotle: The comrectors License Law tloes not apply to an owner of pmpeny who huilds or Improves thereon, end who contracts for such project with a contractor(s) .
license pursuant to the Contrectors License Laws,): �
❑ lam
Business antl Protessions Code for this reason:
by dnver's license. � Ves ❑ No
of Ownership by (type ol documem, i.e. - property tac bill
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
No.
❑ I hereby certify that no excavetion five (5) or more feet in depth imo which a pereon is requiretl to descend, will be made in wnnaction with work euthonzed 6y ihis
pertnit, end that no builtling strucWre, scaftoltling, falsework, or tlemolition or tlismantling thereot, will be more than thirty-si: (38) feet high. (Chap. 32, Gry 2, Ar12, Sec.
341, Title 8, Calitornia Adminisiretive Code).
❑ As awner-builder, I will not employ enyone to do work which would require a permit irom the Division of Industriel Sefety, as notetl ebove, unless such person hes e
permit to do such wark trom ihe division.
Signature: Date:
Division of Industrial Safery Permit Numher:
CERTFICATE OF COMPLIANCE ANO AViHORIZATION OF ENTAY: I certity under penalry ot perjury �hat I have reatl this application and state that the intormation given is
conect I agree lo comply with ell s�ate laws and ciry ortlinances relating to building cons�ruc�ion, and euthonze representatives of ihe City ot Costa Mesa to enter upon the
ebove-descnbetl pmperty for inspection purposes. I egree not to wcupy or allow occupancy ot any building authorized by ihis permit until final inspection.
� Signeture Of Legal Owner(s)
COUEI, INSPECTIONTYPE
1616 Fixed System Final Fire Prevention
1266� Paal Spe Finel
200 Finel RB-Root
201 Finel Block/Retaining Weli
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
V9IE iNrrtia�s
COOE 1 INSFECTION TYPE
206 Final Mec�anical
208 Finel Plumbing
210 Final Electncal
212 Final Fire Prevention
220 Final Planning ApProval
222 Final Site
250 Final BuiltlincyOccupancy
m
IbS1�Cif�iL\4j
,lobAddress: 367 22NDST
Suite:
Vicinity: SPA
Primary Occ: R-3 Dwellings/ Cong Res <10 Type ot Construction:
Parcel Number: 42617117 Zoning:
npp�iwnt: DITULIO, CHRIS
Address: 22343 LA pALMA
SUITE 104
YORBq LINDA, CA
owner: MITCHELL, STEPHEN H TR
Address 361 22ND ST" -
COSTq MESA, CA
Contractor: MAS7ERPIECE POOLS AND SPAS INC
Address: 22343 LA PALMA
SUITE �p4
YORBq LINDA; CA
Arch :
Address:
Zip:
Phone: 714-692-1132
Zip: 92887 ISSUED BY:
Phone:
Zip: 92627-1800
Phone: 714-692-1132
Zip: 92887 License: 804110
Phone:
License:
Eng: AARON COWE
Address: 1201 N TUSTIN AV
ANA, CA
92807
Status: ISSUED
Applied: 12l21/2006
Issued: 1221Q006
Phone: 714-630-6100
License: C58878
SCOPE OF PERMIT
INSTALLATION OF A 50 SF IN-GROUND GUNITE SPA AT THE REAR OF AN EXISTING SFD.
FEE SUMMARY
Plan Check: $172.41 Calc Valuation: 3�5,s5o.o0
Permit: $265.25 Claim Valuation: Ei5,9eo.00
SMIP Res: $1.60
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $439.26
PLANNING 8 ZONING
SETBACKS
MAINSTRUCTURE Front,��0-0
ACCESSORY Front 0-0
PARKING Existino: p
Rear 0-0 Left 0-0 Right 0-0
Rear 0- 0 Left 0- 0 Righ� 0- 0
Reauired: 0. Praoosed: 0
NOTICE: The work authorizetl by this permit shall comply with all applicable handicap access requirements under Califomia staWtes and related
regulations. (Ord. No. 92-28, § 1, 12-27-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or it work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order tor ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inspectlons and tlnel epproval must be oblained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (7y 4) 7545626 �
24a&GB (8/00)
�
WORKERS' CtlMPENSATION DECLARATON:
I hereby affirtn U�der penalry ot Oerjury ona of the following dadarations: �
❑ I heve end w�ll maintain a certilicate oi consent to selt-Insure for workers' compensation, es provided for by section 3700 of the Lebor Cotle, for the pertormance of the
�work for whic� Ihis permii is issuetl.
I have and will maintain workers' compensation insurance, es raQuired by section 3700 of the Le�or Cotle, for the pertortnance ot the work tor which this pertnit is issued.
My wod rs' compensarYW n Ins ence carner and policy number are: I l
Carner: 1 ^+ PolicyNumbec � �N ��-I �0 ���Q Y�
(This secfion need not be compleled I! fhe Oermit is v ed ef one hundretl dollars ($100J or Iess.J
❑ I tertity thP� in the paAor ance ol ing.�york which Ihis pertnit is issued, I shall nol employ eny person in eny menner so as to 6ecoma suhject to Ihe workers'
compensa�ion laws ol I lornle, a e Br aI II I should bacome sublect to Ihe workers' compensation provislons ol Sectlon 370p oi the Lebor Code, I shall forthwith
comply with these pr J' s. I
Applicent SignaNre: Dete: �� I i � IO �i
WARNING: FAIWqE TO SE WORNE ' C MPENSA ION COVEPAGE IS UNLAWFUL AN� SHALL SUBIEGT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDPED
THOUSANDOOLLARE(St ,OW),INAODITIQYTOTHECOSTOFCqMPENSATION.DAMAGESASPROVIOEDFORINSECTION3]OBOFTHELABORCO�E,IMEREST,ANDATfORNEV'SFEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aNirm tnat I am licensetl u tler provisions of Ch ter 9(commencing with Section 7000) of Division 3 of the eusiness antl Professions Cotle, and my license is in full
force and eflect. �ic. W � Class a r���
ConlreClorsSignalure: /{7,. ,�; Dale: � /� �
�77T➢ i . i � n T �T� ¢
��
CONSTRUCTON LENDING AGENCV:
❑ I hereby aHirtn that there is e consiruction lentling agency lor Ihe peRormance ol the work for whic� this permit is issuod. (Sec. 3097, Civil Code).
Lenders Name: Lentler's Address:
SigneNre:
OWNER•BUILDER DECLARA710NS:
Dato:
I hereby eHirm tt+ai untler penalry at perjury that I am EXEMPT FROM 7HE CONTRAC70R5 LICENSE LAW for Ihe following reason (Sec. 7031.5, Business and Professions
Code: Any ciry or county which requires e pe�it to construct, alter, improve, tlemolish, or repair any structure, pnor to its issuance, also requires the applicant for such pertnit
ro file e signetl s�atement that he or she is litensed pursuant to Ihe provisions of ihe Contractors License Law (C�apter 9(commencing with Seciion 7000) of Division 3 oi the
Busin855 and Professions Code) or Ihal he or 5he is exempt therefrom and lhe basis for Ihe alleged ezemption. Any violation ol Section 7031.5 by any applicant for a pertnil
subjects tha applicant to a dWl penalry of not more than five hundred dollars (5500J.):
❑ I, es owne( of the property, ar my employees with wages as their sole compensation, WILL DO 7HE WORK, and the strucWre Is not intendetl or offeretl lor sale (Sec.
7044, Business and Professions Code: The Coniractors License Law dces not apply lo en owner of propeny w�o 6uilds or improves thereon, and who does such work
himself or nerself or through his or her own employees, provided that such im0�o�ements ere not intentled or oMeretl br sele. Ii, however, the building or improvement is
soltl wit�in one year of completion, ihe owner-builder will have ihe burtlen oi proving ihat he or she did not build or improve �or purpose of sale.).
❑ I, as ownef ol ihe property, em EXCLUSIVELV CONTRACTING WITM LICENSED CONTRACTORS to constmct Ihe projecl (SecJ044, Business and Professions
Cotle: The contracmrs License Law tloes not apply to en owner oi property who builtls or Impmves thereon, and who coNracis br such project with e contracbr(s)
license pursuant to lhe Conirectors L'Icense Laws.).
❑ I em ezemp� under sec. Business and Professions Cotle for this reason:
Signature: Dare:
Owner ID veritied by tlrivefs license. ❑ Yes ❑ No Drivefs License No.
Verificetion ot Ownership by (type of daumem, i.e. - propeny tax bill or deed):
DIVISION OF INPUSTRIAL SAFETY PERMIT CERTIFICATION:
Expires.
� I hereby cenify tha� no excevetlon flve (5) or more feet in tlepih into which a person is requiretl to tlescend, will 6e made in connection with work aWhorized by ihis
permit, end ihat no building s�mcWre, scettolding, falsework, or demolition or dismantling ihereot, will be more ihan thiny-s�z (36) fee� high. (Chap. 32, Gry 2, Atl 2, Sec.
341, TIUe 8, Califomle Adminisirative Cotle).
❑ A5 ownervbuilder, 1 will no� employ enyone to tlo work which would reQuire a permit twm ihe Division ol Intlustrial Sufety, as noted above, unless such person has a
permi� to d0 such work tmm ihe tlivision.
Signalure: Da�e:
Division of Indusinal Safety Pertnit Number:
CER7IFlCATE OF COMPLIANCE AND AUTHORIZATION OF ENTRV: I cenify under penalty ot perjury that I have read t�is application and state that the information given is
correct. I agree �0 �omply with ell state laws and ciry ordinances relating to building construclion, end euthorize representatives ol t�e City of Cosla Mesa to entar upon the
above�descnbed property for inspection purposes. I agree not to occupy or allow occupancy of any building amhorized by this permit until final inspection.
SODE �, f(�$�nONT'PE
1616 Fiaetl Sys�em Final Fire Prevention
1266
200
201
202
203
Pool Spa Final
Finel Re-A��
Flnel Blo�k�Retaining Well
Final Fadory Fire Placa
Final Sign
204 Final Demolition
�Aj� �NTIiIALS
�� �
I> �Date
21 0 �,
Date
SODE� INSPECiIONTYPE
206 Final Mechanical
20B Final Plumbing
270 Final Electrical
212 Finel Fire Prevention
220 Flnal Pianning Approval
222 Final Si�e
250 Final Building/Occupancy
jly/jF IHi111��
�� "D" �� %� �uu�C�i�s f �ufiQiact
POOL AND SPA REQl11REMENTS
The following information is required in a clear and legible manner. All infortnation shall be complete and on
[he plans.
Three sets of plans showing all of [he following with measurements shown from property lines, buildings,
patio covers or other s[ructures.
1. Name, address, phone number of owner.
2. Name, address, phona number, type of license of any contractors or subcontractors.
3. Pool and/or spa location.
4. Equipment location.
5. Gas and electrical meter locations.
6. Overhead service lines and serving pole loca[ion.
7. Type of gas and elecvical conduits to be used.
8. Size of main elec[rical service (if less than 100 AMP, service is probably inadequa[e and will have to
be upgraded to minimum City requirementsJ
9. Rating (horsepower, voltage, amps) of all electrical equipment.
10. BTU rating of gas heater.
I 1. Distance and size of gas line.
12. All electrical oude[s wi[hin 15 ft. of pooVspa.
13. Capacity of spa (spas only).
14. Handrails, ladders, slides and diving boards (if any).
15. Location and details of solar panels (if any).
16. Location of doors and windows wi[hin 5 ft. of pooUspa.
17. The type of construction—gunite, poured concrete, prefabricated fiberglass or other.
18. The pool dimensions, including the dep[h and adequa[e cross-sections drawn to scale.
19. Computations, stress diagrams and other data sufficient to show the correctness of plans; including
reinforcing steel schedule and details.
20. A statement by the applican[ conceming the anticipated nature of [he soil under and around the pool
structure (expansive, moderately expansive, non-expansive). (A soils report may be required by
Building Division prior to pertni[ issuance.)
21. The Engineer's wet ink signature is required on pool plans and calwlations.
22. All semi-private pools and spas shatl conform to California Administrative Code Tide 24
handicapped requirements (ho[els, motels, recreation areas for lease to public or publicly funded
projects).
23. Where a permanendy installed pool is consWcted, a[ leas[ one ]20 volt recep[acle shall be installed a
minimum of 10 feet and not more than I S feet Gom the inside wall of the pool and shall be protected
by a ground faul[ cirwit in[errupter.
24. Indoor installation of spas and hot tubs, recep[acles shall not be closer [han five (5) feet to spa/tub.
25. Receptacles located within twenty (20) feet of a spa or hot tub shall be G.F.C.I.
26. Receptacles for spa/hot wb motors shall be G.F.C.1. protected.
27. Comply with Costa Mesa City ordinance 93-12 requiring protective barriers, fencing and/or
enclosures.
1UJY-Mi (HtV.P/ytl)
GENERAL REQUIREMENTS
1. If capacity is 750 gal. Or more, backwash and P-Trap shall be installed.
2. All P-Traps shall tie in at lower terminus of house drain.
3. [f permanent fill line is no[ installed, neazest hose bib shall have an an[i-siphon valve.
4. All PVC shall be 18 inches underground.
5. PVC gas lines shall be [ested at 60 P.S.I.
6. Pressure test required on entue sys[em (35 P.S.I. air test or water fill) prior to back fill.
TYPICAL SETBACK REQUIREMENTS
Equipment 4 ft. from property line
4 ft. from doors/windows
4 ft. from attic vents
1 S inches from house/garage
Pool/Spa: 5 ft. from propeRy line
5 ft. from struc[ures
1. Overhead Edison drops shall be installed per NEC 680-8 (see attachment).
2. It shall be unlawful for any person to install, remove, alter, repair or replace any plumbing, gas or
drainage piping or any fixture, swiauning pool heater or [reating equipment in a building or
premises without first obtaining a permit to do such work from the City Building Division.
3. Clarification or additional information may be obtained by telephone: (714) 754-5273, between
8:00 a.m. and 430 p.m.
FENCE AND GATE REQUIREMENTS (see attached)
1039-06 (REV. ]/98)
JobAddress: 367 22NDST Status: ISSUED
Suite No Applied: 12/21/2006
Vicinity: SPA Issued: 12/212006
Parcel Nunmber: 42617117
npplicant: DITULIO, CHRIS
Address: 22343 LA PALMA
SUITE 104
YORBA LINDA, CA
owner: MITCHELL,_STEPHEN H TR
Address 36122ND ST �.
COSTA MESA, CA.-
Phone: 714E92-1132
Zip 92887
Phone:
Zip: 92627-1800
Corrtractoc MASTERPIECE POOLS AND SPAS INC
Address: 22343 LA PALMA
SUITE 104 Phone: 714-692-1132
� YORBA LINDA, CA Zip: 92887
License: 804110
ISSUE FEE
Temp service test
Res. a/c package
New Res (1-2 units)
New Res (3+units)
Pool / Spa
Lighting Fixfs
Recept Outlets -
Swilches
Non Res Appl
Res Appl
Service to 200a
Service to 1000a
Service over t000a
Motors to thp
Motors to 10hp '
Motors to 50hp � �
Motors l0 100hp .
Motors over t00hp
Communication drops
Sub panel to 200a
Pole LigM Pkg
Siqn Circuits
Temp Pwr Pole
Intermed Pole
ISSUED BY:
SCOPE OF PERMIT
INSTALLATION OF A 50 SF IN-GROUND GUNITE SPA AT THE REAR OF AN EXISTING SFD.
REF: BO6-02164
1 SPA
$23.50
$0.00
$0.00
$0.00
$0.00
$49.50
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
\$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Quantiry
_p
0
t
0
0
0
0
0
0
0
0
- 0
0
0
0
0
0
0
0
0
0
0
FEE SUMMARY
Temp Dist System / Lighting
Busway I100 N
Standing Section
- Misc Electrical Equipment -
Transformers up to 1 kva/kw
................up to 10 kva/kw
.................up to 50 kva/kw
.................up to 100 kva/kw
..................over 100 kva/kw
. Low Voltage Equipment
" Low Volt Winng System / Ckt
Misc. Conduit
Misc. Conduclor ' �
- Circus ( gen or ride) �
Circus (mech nde or lights)
Christmas Tree Stand
Fireworks Siand
Other Eledrical Fea
Investigation Fee
Plan Check Fee
Reinspection Fee
Quantiry
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
so.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00
$0.00
$0.00
$0.00
�. TOTAL CALCULATED FEES 573.00
COMMENTS I SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 180 days, or if work is suspendetl or abandoned
for a period of 180 days. �
INSPECTIONS: In order for �he work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspectlons and tinel approval must be obtained. Failure to obtain inspections and tinal approval will result in the expiration of this permiL�
FOR INSPECTIONS CALL: (714) 7545626
zm�as (sioo�
WORKERS'COMPENSAnON DECLARAnON:
I hereby aXirm under penelry oi perjury ona of the following deGarations:
❑ I have antl will maintein a certificate of consent to selbinsure tor workers' compensation, es pmvitletl for 6y section 3700 0l the Lebor Cade, lor the peAormance of the
�wOrk for whiCh IhiS permit Is issued.
I have end will mainfein woBere' compansation insurance, as required by section 3700 of ihe Labor Cotle, for the petlormance of the work for which Ihis permit is issuetl.
My workers' wmpe�satio✓n Insuren1ce wrner entl policy number are:
Carnar: �G��l_v�vfA PolicyNumber.����ZIIn—�0��_
(This seclion neeTdnot be completed il the permi( is valued et aie bundred dollars ($100) or less. J
❑ I tertify �hat in �he perfo ce of �he work for. ich ihis permit is issuod, I shall not employ any person in any mennei so es Io become subjeci �o Ihe worker5'
compensation laws ol omle, end e6F if I should becOme subiect to the workers' compensation provisions ol Sectlon 3700 0l the Lebor Cotle, I shell forthwith
comply with Ihese p� � �� l �
Applicant SigneNre: �� Date: I��� � f 7 �n
WARNINQ: FAILURE TO SE U E WORKERS' CAMPENSATION CqVEFAGE IS UNLAWFUL AND SHALL SU&IECT AN EMPLOVER TO CRIMINAL PENALTIE$ AND CIVIL FMES UP TO QYE HUNDRED
THOUSAND DOLLARE (310p,0001. IN ADDITION TO THE COST OF CqMPENSATION, DAMAGES AS PROVIOEp FOR IN SECTION 39060F THE IABOR CODE, INTEREST, AN� ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby eNirm that I am license �der rovisions of Chaptar 9(commencing with Section 7000) of Division 3 of the Business end Profassions Code, and my license is in full
force entl eNect Lic. M Cless q
Contractofs Signawre: Date: ��T� ���
i
CONSTRUCTION LENDI G AGENCV:
❑ I hereby affirm thal Ihere is a construction lending aqenty for Ihe peAormance of Ihe work for which this pertnit is issuetl. (Sec. 3097. Civil Cotle).
Lendefs Name: Lender'S Address:
Signature:
Date:
OWNER•BUILDER DECLN7ATIONS:
I hereby aHirm thel under penalry of perjury t�et I em EXEMPT FROM TME CON7RACTORS LICENSE LAW for ihe lollowinq reason (Sec. 7031.5, Business and Professions
Cotle: Any ciy or counry w�ich requires a Oertnit to construct, alter, improve, tlamolish, or repair any strudure, O�ar to ils issuance, also requires the epplicant for such permii
to file a signed stetament thet he or she is Ilcensed pursuant to the provisions ot the Contractors License Law (C�apter 9(commencing wiN Section 7000) of Division 3 of the
Business end Prolession3 Code) or that �e or she I5 exempt therefrom and the basis tor the alleged exemption. Any violation ol Section 7037.5 by any epplicant for a pertnit
subjects the eppllcant to e ����� penaly of noI more than (ive huntlred dollars ($500).):
❑ I, es owner ot t�e properry, or my employaes with wages as their sole compensatlon, WILL DO 7ME WORK, antl the siructure Is not intentletl or oHeretl for sale (Sec.
7044, Business and Professions Cotle: The Conirectors License Law dces not apDly to an owner ot property who builds or improves ihereon, end who tloes such work
himself or herself or ihrough his or her own employees, p�ovidad ihat such improvements ere not intendetl or offered lor sale. If, however, the builtling or improvemem is
soltl within one year of completion, the owner-builder will have ihe burden of proving ihat he or she did not builtl or improve for purpose of sale.).
❑ I, as owner of the property, em E%CLUSIVELY CON7RACTING WITM LICENSED CONTRAC70R5 to construct the pmjaM (Sec. 70a4, Business and Pmfessions
Cotla: The contracmrs License Lew tloes not apply to en owner ol propetly who builds or improves thereon, antl who coniracts for such pro�ect with a contractor(s)
license pursuant to Ihe Contractors License Lews.).
❑ I am e:empt under Eec. Business and Professions Cotle for this reason:
Signature: Date:
Owner ID verilied by drive� s license. ❑ Yes ❑ No Driver's LiCense No. Ezpires:
Verilicetion of Ownership py (type of document, i.e. - propercy tax bill or tleed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify ihat no eacavetion Ove (5) or more feet in depih into which a person is requiretl to descenq will be meda in connection with work authorized by this
pertnit, and that no building sWcture, scaHoltling, falsework, or demolition or tlismantling thereot, will be more than �hiny-six (36) leel high. (Chap. 32, Gry 2, Art 2, Sec.
341, TiUe 8, Celibmie Adminlsirelive Cotle).
❑ A5 owner-builder, I wlll not employ anyone Io do work which would require a permit from the Division of Intlustriel Safety, es noted a6ove, unless such person hes e
permlt to tlo such wOrk from Ihe division.
Signature: Date:
Division ot Indusirial Safery Permit Number:
CERTIFlCATE OF COMPUNdCE AND AUTHORIIATON OF EMRY: I certiy under penalty of perjury �hat I have read lhis application antl s�ate that ihe intortna�ion given is
correct. I egree to comply with all stete laws end ciry ordinences relating to building construction, end euthorize representatives ol Ihe City of Costa Mesa to enter upon ihe
ebove-aescnbed propeny for inspection puryoses. I agree not to occupy or aliow occupancy of any building authonzed by this permit until linal inspection.
CODE �.
7676
1266
Fixetl System Finel Fire Prevention
Pool Spa Final
200 Finel Re-Roof
201 Final BIocWReteining Well
202 Finel Factory Fire Plece
203 Finel Sign
204 Final Demolilion
� INTrtIALS
1��Z� �Vi Dare
Date
CpDE� INSPECPONTYPE
206 Finel Mechenical
20B Final Plumbing
210 Final Electrical
212 Flnal Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupency
�E INTffIALS
Job Address: 361 22ND ST Status: ISSUED
Suite No Applied: 12l21Y1006
Issued: 1221I2006
Vicinity: SPA
Parcel Nunmber: 426171�7
Applicant:
Address:
Owner:
Address
DITULIO, CHRIS
22343 LA PALMA
SUITE 104
YORBA LINDA, CA
MITCHELL, STEPHEN H TR
361 22ND ST ,
Phone: 774-692-1132
Zip: 92887
� � Phone:
,� COSTA MESA, CA , Zip: 92627-1800
Contractor: MASTERPIECE POOLS AND SPAS INC
Address: 22343 LA PALMA
SUITE 104 Phone: 714E92-1132
YORBA LINDA, CA Zip: 92887
License: 8047 t0
ISSUED BY:
SCOPE OF PERMIT
INSTALLATION OF A 50 SF IN-GROUND GUNITE SPA AT THE REAR OF AN EXISTING SFD.
REF: BO&02164
1 PRIVATE SPA
ISSUE FEE
BackOow irngation
BackBow Preventer
Bathtub
Clarifer System
Connect (Ice,Soda,etc)
Dental Units
Dishwasher
Drain, Floor
Drain, Rainwater
Drain, Roo(
Drinking Fountain
Expansion Tank
Gas Earthquake Valve
Gas (t-4 outlets)
Gas (Over 4 outlets)
Gas Repipe �
Gas Service
Interceptors (Grease, Oil)
Interceptors (Sand Auto )
AMT
$23.50
80.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$O.DO
$0.00
$0.00
$0.00
80.00
$0.00
so.00
$0.00
$0.00
$0.00
$0.00
$0.00
aTr
FEE SUMMARY
AMT
LaundryTub/Washer $0.00
Landswpa Irrigation $0.00
. P-Trap ' $0.00
- Pressure Regulator 50.00
Process Piping (per 10 ft) $0.00
Receptors $0.00
Septic Tank $0.00
Sewer Cap for Demo $0.00
Sewer Connecl $0.00
Sewer Private Line 30.00
Shower $0.00
Sink; tiar � $0.00
� Sink, commercial $0.00
Sink, Floor $0.00
Sink, kitchen $0.00
� Sink, service/mop $0.00
� � Spa (private) $30.25
- Spa (public) $0.00
�
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
COMMENTS / SPECIAL CONDITIONS
SumpPump
Swimming Pool
Trap Primer
Urinal
Vacuum Brkr Bkflow(1-4)
Vacuum Brkr Bkflow(5+)
Wash Basin
Wash Basin Set
Waste and Vent System
Water Closel (Toilet)
Water Heater / vent
Water Piping (Inst or Rep.)
Water Re-pipe
Water Service
Water Soflener
OTHER
VIOLATION
PLAN CHECK
REINSPECTION
TOTAL CALCULATED PEES:
AMT
$0.00
$0.00
50.00
50.00
$0.00
so.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
so.00
$0.00
$0.00
$0.00
553.75
�
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO710E: The work authorized by ihis permit shall comply with all applicable handicap access requiremenis under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically ezpire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a penod of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inspectlone and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626 �
244&46 (8�00)
WORKERS' COMPENSATION DECLARATION:
I hereby aRirm untler penalry of perjury ona o� the following declarations:
❑ I have entl wlll meintain a certificate at consent to self�lnsure for workers' compensation, es proviaetl for by section 3700 of ihe Lebor Code, tor the performance ot the
�work for which ihis permii is issued.
I have and will maintain workers' compensation insurance, as requiretl by section 3700 of the Labor Cotle, for the pertortnance ot the work for which Ihis permit is issued.
My workers' c�o�m�ensatriqn Ins4rance carrier and policy number ere: q I ,n
Cerrier. �[ rJNd Policy NumDer: I �(n 7�I V— lv� 6
(This section need not be canplefed i! the pe��t is valued af one hundred dollars ($100J or /ess.)
❑ I certity that in the pertor ce of ihe r hich ihis permit is issuetl, I shall not employ eny person in any manner so as to become su6ject to the workers'
compenselion laws of f ia, en e8 th t il I should become sublect lo the workers' compensation provisions of Seclion 370p ot Ihe Labor Code. I s�all forthwith
comply with these pr i / I I
Applicent Signature: � Date: � ZI � � ��0
WAqNING:FAIWRETOSE REWORKERS NSATIONCOVEPAGEISUNIAWFUlrW�SHALLSUBIEGTANEMPLOVERTOCRIMINALPENALTIESANDGVILFINESUPTOQVEHUNDRED
TFIOUSANO DOLL4RE (5100,000), IN ADDRION TO TME COST OF COMPENSATION, DAMAGES AS PROVIDEO FOR IN SECTION 3�OB OF THE LABOP CAOE. IMEREST, AND FTfORNEYS FEES.
LICENSED CONTRACTORS �ECLARATION:
I hereby attirm that I am
torce and eflect. Lia N_
ComractoYs Signawra:
9(commencing with Sectian 7000) of Division 3 of the Business antl Prolessions Code, antl my license is in tull
CI255 k C �
Date: �'� I> � O 6
CONSTRUCTION LENDING AGENCY:
❑ I hereby attirm tha� there is a consWction lending agency lor ihe peAormance ol ihe work for w�ich this pertnit is issued. (Sec. 3097, Civil Cotle).
Lantlefs Nama: Lenders Atltlress:
Signecure:
Date:
OWNER-BUILDER DECLARATIONS:
I hereby aMirm that under penalry ot perjury tnat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business antl Professions
Code: Any ciry or counry which requires a pe�it to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires ihe applicant for such permit
to tile a signed statemant thet he or she Is IiGensetl pursuant ro Ihe pmNslons ol the Coniractore Llcense Lew (Chepter 9(commendng with Sectlon 7000) of Dlvlsion 3 at ihe
Business end Prolessions Cotle) or that he 0� sha is exempt therefrom and the basis for the allegad ezemptlon. Any violetion oi Section 7037.5 by eny epplicant lor a permit
sublects the applicant to e civil penalry of not more than tive hundred dollars ($500).):
❑ I, es owner of the properry, or my emplDyees with wages as iheir sole compensa�ion, WILL DO TNE WORK, and Ihe structure is not iniended or oHeretl for sale (Sec.
7044, Business antl Professions Code: The Contractors License Law does not apD�Y �o an owner of properry who builds or improves ihereon, and who tloes such work
himself or herself or ihrough his or her own employees, provided ihat such improvements ere not intentled or olfered for sale. If, however, �he building or improvemem is
sold wi�hin one year oF completion, ihe owner-builtler wiil have ihe burden of proving Ihat he or she tlitl not build or improve for purpose ot sale.).
❑ I, as owner ol the property, am EXCLUSNELY LONTRACTING WITM LICENSED LONTRACTORS to constmct the project (Sac. 7044, Business end Pmfessions
Code: ThB coniracmrs License Law dods not apply to an owner ol property who 6uild5 or improves Ihereon, antl w�o contracts /or such pro�ect with e con(ractor(s)
licensa pursuant b the Contractors Lic6nse Laws.).
❑ I am eaempt under sea Business and Professions Code tor t�is reason:
SigneWre: Date:
Owner ID veritied by drivar's license. ❑ Ves ❑ No Driver's License No. Expires:
Venfication oi Ownership by (type of dxument, i.e. � propeny tax Oill or deed�:
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTiFICATION:
❑ I hereby certify Ihat no excavetion five (5) or more feat in tlep�h into which e person is required to tlescend, will be made in connection with work authorized by this
permit, and that no 6uilding siructure, scattolding, falsework, or demoli�ion or dismantling Ihereof, will be more ihan thiny-six (36) feet high. (Chap. 3.2, Gry 2, An 2, Sec.
341, Title B, Caiitomia Administrative Code).
❑ As owner-builder, I wili not employ anyone Io do work which would require a permit irom ihe Division of Industriol Sofety, as nOled ebove, unless such person hes e
permit to tlo such work Irom the division.
Signature: Oale:
Division of Industrial Salety Pertnit Number.
CERTIFlCATE OF COMPLIANCE ANO AUfHORIZATION OF ENTRY: I certify untler penal�y of perjury that I have read Ihis epplication antl state t�at the information given is
correct. I agree m comply with all stete laws and ciry ortlinances relating to building construction, entl authonze represematives of the Ciry of Costa Mesa to emer upon the
ebove-described property tor inspection puryoses. I agree not to occupy or allow occupancy of eny Duilding authorized by this permit until final inspeclion.
COpE �. INSPECTIONTYPE RT INTffIALS
1616 Flaed System Final Fire Preven�ion
1266 Pool Spa Final
200 Final Re-Roof
201 Final BIocWRetaining Wall
202 Final Factory Fire Place
203 Final Siqn
204 Final Demolition
Date
��.(�� �b
Date
COOE� INSPECTIONTYPE
206 Finel MechaniWl
208 Final Plumbing
210 Finel Electrical
212 Finel Fire Prevemion
220 Finel Plenning Approval
222
250
Final Site
Final Building/Occupanry
�E ��
.qe �
(714) 754-5273 • Fex (714) 754-4856 • www.ci.eosta-mesa.ce.us 77 FAIR DFIVE, COSTA MESA, GA 92626
ELECTRICAL PERMIT
Job Address:
Suile No
Vicinity:
ParcelNunmber:
Applicant:
Address:
361 22ND ST
42617117
PATTON,DONALD
1018 NOTTINGHAM RD
NEWPORT BEACH, CA .
owner. MITCHELL; STEPHEN H TR
Address 381 22ND ST ` , �
/ � - � �
� COSTA MESA, CA �
Phone: 949-644-8696
Zip 92660
Phone:
Zip: � 92627-1800 � . .
�.
Contractor. ' DONALD PATTON CONSTRUCTION INC
Address: 1018 NOTTINGHAM RD
� � Phone� 949-644-8696
` NEWPORTBEACH,CA
Zip: - 92660
License:521850 �
SCOPE OF PERMIT
-� � 400A SERVICE W/TEMP PIGGY BACK SERVICE ON METER FOR A 2,802 SF ADDITION TO SFD (858
SF TO 1ST FLOOR AND 1944 SF TO 2ND FLOOR) AND 107 SF ADDITION TO GARAGE.� �
, " REF#: B05-02157% �'-: , ` - ,
Status: ISSUED
Applied: 07/14/2006
Issued: 07/142006
ISSUED BY:
i y -
�-,,, -
., �
. ...- _.j` _.- '
` � � . �\ �
ISSUE FEE
Temp service test
Res. a/c package
New Res (1-2 unils)
New Res (3+units)
Pool / Spa
Lighting FiMs
Recept.OuHets -
Switches
Non Res Appl
Res Appl
Service to 200a
Service to 1000a
Service over t000a
Motors to thp '
Motors to tOhp
Motors to 50hp
Motors to 100hp
Motors over 100hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Sign Circuits
Temp Pwr Pole
Intermed Pole
, , .. .
Quan(ity -
523.50
$0.00
$0.00
$Q00 � 0
so.00 ,. "o
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$62.15 1
$0.00 0
$0.00 - 0
$0.00 0
� $0.00 .� : . 0
$0.00 0
$0.00 0
$0.00 % � � � 0
�,$0:00 �J�f;� -0 �
� �$0.00�� � .0�.
$0.00 �' 0
$0.00 0
$0.00 0
�
FEE SUMMARY
Temp Dist System! Lighting
Busway /100 ft �
. , _ Standing Section �
� Misc Electrical Equipmenf �
�� . Transformers up to 1 kva/kw
.. � ..:.........:.:.up to 10 kva/kw
.................up to 50 kva/kw
.......... "......up to 100 kvalkw
........r.........over 100 kva/kw
Low Voltage Equipment
, low Volt Wiring System / Ckt
Misc. Conduit
Misa Condudor
Ciicus ( gen or ride) -
Cirws (mech ride or lightsj
Christmas Tree Stand
Fireworks Stand
Other Electrical Fee
Investigation Fee
Plan Check Fee
Reinspection�Fee
Quantiry
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0 �'. ,
$0.00 0
$0.00 0 `
$0.00 0 ,
$0.00 0�' ' '
$0.00 ,'�0 � �
$0.00 - - 0
$0.00- 0
$0.00 0
$0.00 0. .
$0.00 0
80.00 ' 0
$0.00 0
$0.00
$0.00'
$0.00 !! j
$0.00
TOTAL CALCULATED FEES §85.65
COMMENTS / SPECIA! CONDI710NS
NOTICE: The work authorized by this pertnit shall comply with all applicable handicap access requlrements under
regulations. (Ord. No. g2-28, § 1, 12-21-92) ,
EXPIRATION: This permil shall automatically expire and become void if work is not commenced wlthin 180 days, or�lYw
for a period of 180 days, u
statutes antl related
is suspended or abandoned
INSPECTIONS: In order for ihe work authorized under this permit ta be considered legal, such work must comply with all applicable codes, and all
required inapectlone end tlnal approvel must be obtained. Feilure to obtain inspections and (inal epproval will result in the expiration of lhis permit.
FOR INSPECTIONS CALL: (714) 754-5626
zaas�+s (sioo)
WORKERS' COMPENSATION DECLARA710N: �
I hereDy eflirm under penalry of perjury one of ihe following tleclarations: �
❑ I heve end will maintain a ceniticete of consent to salf-Insure for workers' compensalion, es provitletl for by section 3700 of iha Lebor Code, for ihe peAormence of the
work lor which ihis pertnit is issued.
❑ I have.end.wlll maintain workers' compensetlon Insurence, as requiretl by section 3700 of Ihe Lebor Code, for iha pertortnance of t�e work tor which Ihis pertnit la Igsuetl.
��y.workere'�compensation Insurence cerrler end policy number are:
Cerriei:� ST�i7"� f'[/NC� policy.Number—� � OOO �19%O
(Thls'section neeC not be completed 1! fhe permlt fs valuetl et one hundred dollers ($f 00) or less.)
❑ I cartity that in ihe peAo ance of �he work for which this pertnit is iuuetl, I shall not employ any person in eny mannar so as to become subject to �he workers'
compansation laws of fomie, end egree that ii I shoultl become sub�ect to t�e workers' compensetion provlslons ot Sedion 3700 of /[he Lebor Code, I shell forihwith
ApPlicant'S A eltu�rehese p�! ����� ��, `Det��7��%Y ��O
.(��� /`lL
��ARNINO:FAILURETOSECUREWORKERS'COMPENSAT10NG1�VERAGEISUNIAWFULrWDSHALLSUBIECTPNEMPLOVERTOCRIMIWILPE TIES DGVILFlNESUPTOONEHUNDREO
TFIOUSAND OOLLAFE (5100,000�, IN ADOITION TO THE COST OF COMPENSATION, DAAMGES AS PROVIDED FOR IN SELTION 3108OF TME IABOR WOE, IPREREST, AND ATTORNEI"5 FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aXirtn that I am licans�d under�rovislons oi Chapter 9(commencing wlth Section 7000) af Divislon 3,of�ihe�Buslne�and Professions Code, and my Ilcense is in full
�CONSTRUCTION LENDING AGENCY: ' �
❑ I hereby ettirtn thal there is a construction lending a9ency For the pertormance oi Ihe work for which ihis pertnit is issued. (Sec. 3097, Civil Code).
LentleYs Neme: LentleYs Atltlreu:
Signawre:
OWNER•BUILDER DECLARATIONS:
Date:
I here6y eNirm thet under penelry of per�ury ihet I em EXEMPT FROM TME CON7RACTORS LICENSE LAW for Ihe tollowing reason (Sec. 7031.5, Business end Professions
Coda: Any ciry or counry which requires e permit to consiruct, elter, improve, demolish, or repair any siructure, pnor to its Issuence, also requires Ihe epplicent for such pertnit
to file e slqned statement Ihat he or ahe Is Ilcensetl pureuent to ihe provislonc of ihe Contractors License Law (Chepter 9(wmmencing with Sectlon 7000) of DlWslon 3 of ihe
Business end Professions Code) or that he or she is exempt therefrom entl Ihe besis for the ellegetl exemD�ion. Any vloletion of Section 7031.5 by eny epDlicant for e pertnit
sub�ects the epplicent to a ciNl penalry of not more ihan five hundred dollers ($500).):
❑ I, es owner of the proparty, or my employees with wages as their sole compensatlon, WILL DO TliE WORK, antl the structure is not intentleA or ottered for sale (Sec.
7044, Business end Professions Cotle: The Contractors License Lew does not apply to an owner ot properry who builds or improves thereon, entl who does such work
hlmself or herseH or throu9h hls or �er own employees, provided thet such improvemenis are not intended o� oXeretl for sale. If, however, ihe bulltling or Improvement Is
eold wiMin one year of complation, ihe owner-builtler will have Ihe burden of praving that he or she did not build or improve for purpose oi sale.). •
❑ I, as owner of the property, em EXCLUSIVELV CONTRACTING WI7H LICENSED CONTRACTORS to consiruct the prolec� (Sec. 7044, Buslness entl Professions
Catle: The comracrore License Law tloes not apply to an owner o1 proporty who builtls or improves thereon, end who comrects for such prolect wlth e contrector(s)
Ilcense pursuant to ihe Coniractors License Lews.).
❑ I em exempt untler sec. Business and Protessions Coda for this reason:
Signature: Date:
Owner ID verifled by driver's Ilcense. ❑ Yes ❑ No Drlvers License No. Ezpires:
Vedfitetlon of Ownershlp 6y (type ot tlaument, I.e. - property tax blll or tleed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify Ihat no excevation flve (5) or more feet in depih Into which e person is requiretl to descend, wlll be made in connection wlih work euthodzeC Dy ihis
permit, entl that no building strudure, scattolding, talsework, or tlemolition or dismantling ihereof, will be more ihan thirty-six (36) feet hig�. (Chep. 32, Grp 2, Art 2, Sec.
341, Tltle 8, Califomia Atlminisiretive Cotle).
❑ As awner-Duiltler, I will not employ anyone to do work which woultl require a permit from the Division ol Industriel Sefery, es notetl e6ove, unleas such pereon hes e
pertnit to do such work lrom the division.
Slgneture: Date:
Divislon of Intlustrial Safery Parmit Number:
CERTIFlCATE OF COMPLIANCE AND AUTliORQATION OF ENTHV: I cenity under penelry of perjury that 1 have read this epplication and stete thet the Infortnation given is
corract. I agree to comply with ell state laws and ciry ordinances relating to building construction, antl aut�otlze reD�esenta�ives ot the Ciry of Coste Mese to enter upon ihe
ebove-tlescribed properry for inspectian puryoses. I agree not to occupy or eliow occupancy of any building euthorized by this permit until final inspecUon.
CQOE 1. INSPECTIONTYPE
1616 Fixed System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Roof
201 Final BIacWRelaining Well
202 Final Factory Fire Place
203 Finel Sign
204 Final Demalition ��.., .
ORTE IIffID6L9
CO�E� INSPECTIONTYPE
�206 FinalMechenical
208 Finel Plumbing
210 Final Eleclrical
212 Finel Flre Preventlon
220 Finel Planninp Approval
222 Final Site .
250 Finel Bullding/Occupancy
�. i uw.
N3L�.' ,� � �
l
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.��.sCTRICAL PERMIT �� FAIR DRIVE, GOSTA MESA, GA 92626
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
Applicant:
Address:
361 22ND ST
42617117
SAM GARCIA
5752 ALFRED AV
Phone: 714-891-9095
WESTMINISTER, CA - Zip 92683
ISSUED BV:
Status: ISSUED
Applied: 09/28/2006
Issued: 09/28/2006
Owner MITCHELL, STEPHEN H TR
Address 361 22ND ST
Phone:
COSTA MESA, CA Zip: 92627-1800�
Contractor. SAMUEL ELIAS GARCIA ROJAS �
Address: 5752 ALFRED AV �
, Phone: 714-891-9095
WESTMINISTER, CA Zip: � 92683
License: 822377 _
ISSUE fEE
Temp service test
' Res. a/c package
New Res (1-2 units)
New Res (3+units)
Pool / Spa
Lighting Fi�Rs
Recept Outlets
Switches
Non Res Appl
Res Appl
Service to 200a
Service to t000a
Service over'IOOOa
Motors to 1 hp
Motors to 10hp
Motors to SOhp
Motors to 100hp ,
Motors over 100hp
Communication drops
Sub panel l0 200a
Pole Light Pkg
Sign Circuits
Temp Pwr Pole
Intermed Pole
SCOPE OF PERMIT
2,802 SF ADDITION TO SFD (858 SF TO 1ST FLOOR AND 1944 SF TO 2ND FLOOR) AND 107 SF
ADDITION TO GARAGE.
REF: BOS-02157 AND E06-00763
60 LIGHT FIXTURES, 55 OUTLETS, 80 SWITCHES
$7.25
$0.00
$0.00
$0.00
$0.00
$0.00
$5120
$47.55
$65.80
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
so.00
$0.00
$0.00
$0.00
$0.00
Quantity
0
0
0
60
55
80
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
FEE SUMMARY
Temp Dist System / Lighting
Busway 1100 tt
Standing Sedion
Misc Electrical Equipment
Transformers up to 1 kva/kw
................up to 10 kva/kw
.................up to 50 kva/kw
.................up to 100 kva/kw
..................over 100 kva/kw
Low Voltage Equipment
Low Volt Wiring System / Ckt
Misc. Conduit
Misa Conductor
Circus ( gen or ride)
Circus (mech ride or lighis)
Christmas Tree Stand
Fireworks Stand
Other Electrical Fee
Investigation Fee
Plan Check Fee
Reinspecfion Fee
Quantity
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 _ 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00
$0.00
$0.00
$0.00
TOTAL CALCULATED FEES $171.80
nnuueurc��c�nvr�w� r�un�r��ue
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 1 BO deys.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspectlons and finel approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihis permit.
FOR INSPECTIONS CALL: (714) 7545626 �
zsae-aa laoo>
WORKERS'COMPENSAnON DECLARAnON: '
I hereby ettirm untler penalry of perjury one of the following declarations: �
❑ I heve and will maintain e certificate ol consent to self-Insure for workers' compensetlon, es provided for by section 3700 of the Labor Code, for the pertormence of the
wark for which this permi� is issued.
❑ I have antl will maintain woMers' compensetion insurance, as required by section 3700 oi the Labor Cotle, for the pedormance of the work for which this permit is issuetl.
My workers' compensation Inswance cartier and policy number are: -
Certier: PoliCy Number:
(This secNon need not be comp/eted il the permit is va/ued et one hundred dWlars ($100) or less.) � .
� I certify that in ihe peAortnance ol iha work br which this pertnit is issueQ I shall not employ any pereon in any manner so as to become subject to the workers'
compenseiion laws of Califomia, nC agrae ihat if I should become subjact to iha workers' compensation provisions ot Sectlon 3700 ot Ihe Labor Code, I shall torlhwlih
camply with thesa pr sions.
nva�_ _...,!�sre�!��- �--o�ej 9-ZB- o �
WARNINO: FAILURE TO SECU W RKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUflIECT AN EMPCOVER'YO CRIMINAL PENALTIES AND pVIL FINES UP TOONE HUNDRED
THOUSPNDOOLLARE�51 , ),I ADOITIONTOTHECOSTOFCAMPENSATION,OAMAGESASPi70VIDE0WRINSECTIIXJ3'1O60FTHELABORCODE,IMEREST,ANDATTORNEY'$PEES.
LICENSED CONTRACTORS DECLAHATION:
I hereby aHirm Ihat I am licensed under provisions
force end ettect Lia4�'N7 � �
with Sectlon 7000) of Division 3 of t, �8iysiness �qd Pro� ssions Code, and my license is in full
Cless N �� �
pe-ta.� q- 2 8-.� 7
GONSTRUCTION LENDING AGENCV:
�
❑ I hereby attirtn that there is a construction lentling agency for the peAormanca of the work tor which this pertnit is issued. (Sac. 3097, Civil Code).
Lenders Name: Lendar's Adtlress:
Signeture:
OWNER•BUILDER DECLARATIONS:
Date:
I heraby eflirm that under penalry ot perjury thet I em EXEMPT FROM THE CONTRACTOFS LICENSE LAW for the following reeson (Sec. 7031.5, Business antl Professions
Code: Any ciry or county which requires a permit to construct, alter, improve, tlemolish, or repair any strucWre, prior to its issuance, also requires the applicant (or such permit
to file e signed statement that he or sha Is Iicensad pursuant b the provisions oi the Contrectors License Law (Chapter 8(commencing with Seclion 7000) ot DlNslon 3 of ihe
Business end Protassions Code) or that ha or she is exempt therefrom and ihe besis for the alleged exemption. Any violation of SeMion 7031.5 by any epplicant tor e pertnit
suhjects the epplicant to a civil penalry ef �ot more than tive hundred dollars ($500)J:
❑ I, es owner of the properry, or my employees with wages as their sole compensation, WILL DO TME WORK, end the structure is not intentlatl or ottered tor sale (Sec.
7044, Business antl Protessions Cotle: The Coniractors License Law does not apply �o an owner of property who builds or improves Ihereon, and who doas such work
himseN or heroelf or through his or her own employees, provided that such improvements ere not intended or oHeretl br sele. II, howevar, tha building or improvement is
sold within one year of completion, the owneo-builtlar will have the burden of pmving that he or she tlid nm build or improve for purpose ot sale.).
❑ I, es ownar of ihe property, am E%CLUSIVELV CONTRACTING WITX LICENSED CONTRACTOFS to consiruci the project (Sec. 7044, Business antl Professions
Code: The contractors License Lew does not epply to an owner oi propeny who builds or Improves ihereon, antl who comracts for such prolect with a contractor(s)
liCenSe pursuant to the Contractors Licanse Laws.).
❑ I am exempt under sec. Business end Profossions Code for this reason:
Signe�ure: Date:
Owner ID verified by drivers license. ❑ Ves ❑ No Drivor's License No. Expires:
Verificetian ot Ownership by (type of document, i.e. - property taz bill or deetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify Ihat no exwvation five (5) or more teet in depth imo which a person is required to descend, will be matle in connection with work authodzed by this
pertnit, and that no building sWcture, scattoltling, talsework, or demolition or tlismantling ihereof, will be more than thirty-six (36) feet hiqh. (Chap. 32, Grp 2, Art 2, Sec.
341, T�le 8, Califomia Admini5irative Code).
❑ As owner-0uilder, I will not employ anyone to do work which would require e permit from Ihe Division of Industrial Salety, as noted above, unless such person has a
permit to do such work from t�e division.
Signature: Date:
Division of Industnal Safery Parmit Number:
CER7IFICATE OF COMPUANCE AND AUTHORVJITION OF ENTAY: I cenity under penalry of perjury that I have reed this epplication and state that ihe information given is
correct. I egree to comply with all state lews and ciry ordinances relating to building construction, end authorize representatives ot ihe City of Costa Mesa to enter upon the
above-described properry for inspection Ourposes. I agree not to occupy or allow acupency of eny building authonzed 6y t�is permit un�il final inspection.
CODE t, INSPECTIONTYPE ORTE
1616 Fixed System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Roof
201 Final BIocWRetaining Wall
202 Final Factory Fire Place
203 Final Sign
204 Finel Demolition
.0
0
COOE I INSPECTION TYPE
206 Finel Mechanicel
208 Final Plumbing
270 Final Elecirical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Sita �
250 Final Builtling/Occupancy
Q�
uui_ .
(714) 754-5273 • Fax (714) 754-4856 • Www,ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
JobAddress: 361 22ND ST
Suite No
Vicinity:
Parcel Nunmber: 42617717
Applicant:
Address:
Owner:
TOM BRENNAN
321 12TH STREET
UNIT 3
HUNTINGTON B�ACH, CA
MITCHELL, S7EPHEN H TR
Address 361 22ND ST
COSTA MESA, Cq
Contracror. TOM BRENNAN PLUMBING
Address: 321 72TH STREE7
UNIT 3
HUNTINGTON B�ACH, CA
PLUMBING PERMIT
Phone: 714-614-5298
Zip: 92648
Phone:
Zip: 92627-1800
Phone: 714-614-5298
Zip: 92648
License: 465099
Status: ISSUED
Applied: OS/12/2006
Issued: OS/12/2006
ISSUED BY: ✓
SCOPE OF PERMIT
2,802 SF ADDITION TO SFD (858 SF TO 1ST FLOOR AND 1944 SF TO 2ND FLOOR) AND 107 SF
ADDITION TO GARAGE. WORK TO ALSO INCLUDE: 238 SF 2ND FLOOR DECKS; COMPLETE REMODEL
OF 1ST FLOOR; CONVERT 80SF OF 3 CAR GARAGE TO STORAGE AREA AND 2 FIRE PLACES, 1 IN
LIVING ROOM AND MASTER BEDROOM (ER 5677). REF.: BOS-02157
PLUMBING TO INCLUDE: 2 BATHTUBS, 2 DISHWASHER, 1 GAS (1-4 OUTLETS), 3 GAS OUTLETS, 1
LAUNDRY TUBNVASHER, 3 SHOWERS, 1 KITCHEN SINK, 8 WASH BASINS, 7 WATER CLOSETS, 1
WATER HEATER, AND 1 WATER SERVICE.
ISSUE FEE
Backflow irrigation
Backflow Prevenler
Bathtub
Clarifer System
Connect Qce,Soda,etc)
Dental Units
Dishwasher
Drein, Floor '
Drain, Rainwater �
Drain, Roof
Drinking Fountain �
Expansion Tank
Gas Earthquake Valve
Gas (1-4 outiets)
Gas (Over 4 outlets)
Gas Repipe
Gas Service
Interceptors (Grease, Oil)
Interceptors (Sand Auto )
AMT
$23.50
$0.00
$0.00
$19.60
$0.00.
$0.00
$0.00
$19.60
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$6.15
$3.30
$0.00
$0.00
$0.00
$0.00
�
0
0
2
0
0
0
2
0
0
0
0
0
0
t
3
0
0
0
0
FEE SUMMARY
AMT
laundryTub/Washer $9.80
Landswpe Irrigation $0.00
P-Trap . $0.00
Pressure Reguiator $0.00
Process Piping (per 10 k) $0.00
Receptors $0.00
SepticTank 50.00
- SewerCapforDemo $0.00
Sewer Connect $0.00
- �� Sewer Private Line $0.00
- � Shower $29.40
Sink, bar . . $0.00
Sink, commercial $0.00
Sink, Floor � $0.00
Sink, kitchen $9.80
Sink, service/mop $0.00
Spa (private) $0.00
Spa (public) $0.00
ctrv
1
0
0
0
0
0
0
0
0
0
3
0
0
0
1
0
0
0
COMMENTS / SPECIAL CONDITIONS
SumpPump
Swimming Pool
Trap Primer
Urinal
Vacuum Brkr Bkflow(14)
Vacuum Brkr Bkflow(5+)
Wash Basin
Wash Basin Set
Waste and Vent Syslem
Water Closet (Toilet)
Water Heater / vent
Water Piping (Inst or Rep.)
Water Re-pipe
Water Service
Water Softener
OTHER
VIOLATION
PLAN CHECK
REINSPECTION
nnnr
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$78.40
$0.00
$0.00
$68.60
$12.30
$0.00
$0.00
$9.80
$0.00
$0.00
$0.00
$0.00
$0.00
TOTAL CALCULATED FEES: 5290.25
arr
0
0
0
0
0
0
8
0
0
7
1
0
0
1
0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
raqulred Inspeetions end finel epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihis permit.
FOR INSPECTIONS CALL: (714) 7545626
WOflKERS'COMPENSAnONDECLARAnON: � � �
I hereby aMirtn under penalry ot perjury one of ihe tollowing declaretions: . . ,
❑ I �ave antl will maintain e certificate of consent to setl-Insure br workers' compensation, es provided for by section 3�00 of ihe Labor Code, for the peAormance of ihe
work tor which this permit is issuetl.
❑ I have antl will maintain workers' compensation insurance, as requiretl by section 3700 of the Lebor Cotla, for the peAortnance of the work tor which this permit is issuetl.
My workers' compensation Insurence carner antl policy number ere:
Carrier. � Policy Number:
(This secfion need not be completetl il the pemrit is valued af one hundred dollars ($100) or Iess.J
�. I certity that in Ihe pedormance of the work for which ihis permit is issued, I shail not employ any person in any manner so as to hecome subject to the workers'
compensation laws ot Calitornia, antl egree that if I shoultl 6ecome su6ject ro �he workers' compensation provisions ol Section 3700 of the Labor Cotle, I shall forthwith
camply with these provis' ns.
Applicant Signature: � ��'�'---- Date: ,S— � Z 'b 6
WARNING. FAIIURE TO SECURE WORKERS' CAMPENSATION COVERAGE IS UNLAWFUL rWD SHNLL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDRED
THOUSAND OOLL4RE (5140,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIOED FOR IN SEC�IQY 3/O60F THE LABOR CODE, IMEFEST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATON:
I here6y aNirm that I am I�setl undar provl5ions of Chapter 9(commencing with Section 7000) of Division 3 of Ihe Busines�s a Professions Code, entl my license is in full
force entl eRect. Lia u �i:b A�� J Gass # �' ��
Contractor's SignaWre: _�UL�� Date: o, ^�L � 6
CONSTRUCTION LENDING AGENCV:
❑ I �ereby aftirm that there is a construction lending agency for ihe pedormance ot ihe work for which ihis permit is issuetl. (Sec. 3097, Civil Cotle).
Lender'S Name: Lentlefs Address:
Signature: Date:
OWNER•BUILDER DECLARATIONS:
I hereDy aHirm ihat under penelty ol perjury that I am EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for ihe following reeson (Sec. 7031.5, Business end Protessions
Code: Any ciry or counry which requires a permit to construct, elter, improve, tlemolish, or repair eny simcture, prior to its issuance, also requires Ihe applicant for such pertnit
to file e signed statement that he or she is licensed pursuant to the provisions of ihe Contractors License Law (Chapter 9(commencing with Sectlon 7000) ot Division 3 of the
Business entl Professions Code) or Ihat ha or she is exempt Iherelrom and the basis Por ihe alleged exemption. Any violation of Section 7031.5 by eny applicant tor a permit
subjects the applicant to a civil penelty of not more lhan five hundred dollars ($500).):
❑ I, as ownar of ihe propeny, or my employees with weges es their sole compensation, WIIL DO 7HE WORK, and the siructure Is not intended or offered for sala (Sec.
7044, Business and Professions Code: The Contracbrs License Law does not appy to en owner of pmperty who 6uilds or improves ihereon, antl who tloes such work
himseli or herself or ihrough his or har own employaes, provitlatl thet such improvements are not intentletl or oNered tor sele. If, however, the 6uiltling or improvemeM is
soltl within ona yaar of completion, ihe owner-builder wili have ihe burden of proving ihat he or she did not build or impwve tor purpose ot sale.).
❑ I, as owner of the property, em E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to cons�rucl ihe project (Sac. 7044, Business and Professions
Code: The contractors License Lew does not appry to an owner of propeny who builtls or Improves Ihereon, antl who comracts for such project with a contractor(s)
license pursuant ro the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for ihis reason:
Signature: Date:
Owner ID venfietl Dy tlnvefs license. ❑ Yes � No Drivefs License No.
Verification ot Ownership by (type ol documem, i.e. - property tax bill or deed):
Ezpires:
DIVISION OF INDUS7RIAL SAFE7Y PERMIT CERTIFICATION:
❑ I here6y certify tha� no eacavetion fiva (5) or more feef in depih into which e person is required to descend, will be matle in connection with work authonied by ihis
permit, and ihat no buHding stmcture, scaRolding, talsework, or demolition or tlisman�linq I�ereof, will be more than thiny-six (3fi) feet high. (Chap. 32, Grp 2, An 2, Sec.
341, Ttle 8, California Administrative Cotle). '
❑ As owner-builder, I will not employ anyone to do work which would require a Oermi� from the Division of Industrial Safety, as notetl above, unless such pereon �as e
parmit to do such work from the division.
Signature: Date: �
Division ot Industrial Safety Permit Numbec
CERTFlCATE OF COMPLIANCE AND AUTHORVATON OF ENTFiY: I certify under penalry ot perjury that I have reaC this application and state ihat ihe intormation given is
wrrecL I egree to comply with all stete laws and ciry ortlinances relating to building construction, end amhonze represen�atives oi the Ciry of Costa Mesa to enter upon the
ebove-described property for inspection purposes. I agree not ro occupy or allow occupancy ot eny building authorized by this permit until tinal inspection.
SignaWre Of Legal Owner(s) Date
And/Or Authonzed Applicant
'S,QQ�y INSPECTIONTYVE
1616 Fized System Final Fire Prevention
1266
200
201
202
203
Pool Spa Final
Final Re-Roof
Final BIocWRetaining Well
Final Factory Fire Place
Final Sign
204 Final Domolition
SODE� INSGECTIONTYPE
206 Final Mechanical
208 Final Plumbing
210 Final ElecMcal
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
,
(714) 754-5273 • Fat (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
JobAddress: 361 22ND ST
Suite No
Vicinity:
Parcel Number: 426171�17
npp�icant: DON SNEED
Address: 8542 LURTHORN DR
MECHANICAL PERMIT
..,'
I
.�,.I _.' �x:.
�Y,
HUNTINGTON BEACH, CA
Owner: MITCHE�L, STEPHEN H TR
Address: � 361 22ND ST
COSTA MESA, CA
Phone: 714-965-1990
Zip: 92646
Phone:
Zip: 92627-1800
Contractor: DLS HEATING AND AIR CONDITIONING
' Address: 8542 LURTHORN DR
Phone: 714-965-1990
HUNTINGTON BEACH, CA Zip: 92646
License:584220 �
�•I
ISSUED BY:
Status: ISSUED
Applied: 09/13I2006
Issued: 09/13/2006
SCOPE OF PERMIT
2,802 SF ADDITION TO SFD (858 SF TO 1ST FLOOR AND 1944 SF TO 2ND FLOOR) AND 107
SF ADDITION TO GARAGE. WORK TO ALSO INCLUDE: 238 SF 2ND FLOOR DECKS; COMPLETE
REMODEL OF 1ST FLOOR; CONVERT 80SF OF 3 CAR GARAGE TO STORAGE AREA AND 2 FIRE
PLACES, 1 IN LIVWG ROOM AND MASTER BEDROOM (ER 5677). REF.: B05-02157
MECHANICAL TO�INCLUDE: 2 FAU < 100K BTU, 1 REPAIR/ALT COOLING/HEAT AND 2
COMPRESSORS/ABSORPTION SYSTEMS 3 TO 15 HP/SOOK BTU.
FEE SUMMARY'
ISSUE FEE
Inst FAU <100 k BTU
Inst FAU >100 k BTU
Repair I Alt Cooling/Heat
Inst / Rep. Recess Wall Htr
Refrig Sys <100 k BTU
Refrig Sys >100 k B7U
Gas Piping
Factory Fireplace �
Hood w/Mech Exhaust
VAV Box
Vent Fan / Single Duct
Appliance
Fire Dampers
Smoke Dampers
Inst or Relocate Appl Vent ��
Air Handlers < 70000ctm
Air Handlers > 10000cfm
Floor Furnace
Floor or Suspend H@ater
Quantiry
$23.50
529.60 2
$0.00 .0
$13.70 1
$0.00 0
50.00 0
$0.00 0
�0.00 0
$0.00 0
50.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
50.00 0
$0.00 0
50.00 , 0
$0.00 0
$0.00 0
$0.00 0
Repair / Alt Absorbtion Unit
� Repair/AltRefrigerationUnit
' - Ventillation System
Evaporelive Cooler
C o m m e rc i a l I n c i n e rat o r
Domestic Incineretor
Comoressors / Absoro�ion Svstems
Upto3hp/t00kBTU
. '��- 3.To 15 hp / 500 k BTU
15 To 30 hp / 1,000 k BTU
30 To 50 hp / 1,750 k BTU
Over 50 hp / Over 1,750 BTU
Boilers
` Upto3hp
3To15hp
15 to 30 hp
30 to 50 hp
Over 50 hp
� Other Mechanical Fee
Investigation Fee
Plan Check Fee
Reinspeclion Fee
TOTAL CALCULATED FEES
COMMENTS / SPECIAL CONDITIONS
Quantity
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
554.30 2
$0.00 0
50.00 0
$0.00 0
$0.00
$0.00
80.00
E121.10
NO710E: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No, g248, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inspections and final approvel must be obtained. Failure to obtain inspections end final approval will result in the expiration ot this parmit.
FOR INSPECTIONS CALL: (714) 7545626
244646�N00)
WORKERS' COMPENSATION DECLARATION:
I hereby alfirm under penalry of perjury one of the following declarations: �
❑ I heve end wlll melmein e certiFlcata of consent to selt-Insure tor workers' compensatlon, es provided tor by sectlon 3700 ot the Lebor Code, for Ihe pertormance of ihe
work tor which ihis pertnit is Issued.
I�h'a've end will maintein workers' compensation insurance, as repuiretl Dy sxtion 3700 of Ne Lebor Code, for the pedortnance of tha work for which ihis permit is Issued.
YMy wo w ensation Insure ce carrier and policy number are:
'Carrier. ��c...� ��+1� Folicy Number.—�5337 —Zc�6
7This section need not be cample�ed i! the permif Is valued ef are hundred dollers ($100) or less.)
❑ I certiry Ihat in the pedormence of thq, brk f r which ihis pertnit is issued, I shell not employ any person in any manner so as to become subject m the workers'
compensation laws of C�li� mia, e d ree hat if I should become subjecl to tha warkers' compensetion provisions of Section 3700 of lhe Labor Cotle, I shall iorthwlth
comply with these pmvisi s. C
Appliwnt Signature: � _ �,Dete�---/ �3 �✓V
WARNW�: FAILURE TO 5 CUFE WORKERS' COMPENSATION COVEPAGE IS UNIAWFUL AND SHALL SUBIECT AN EMPIOVER TO CiiIMINAI PENALTIES AND CIVIL FlNES �P TOONE HUNDFED
THOUSAND OOLLARE ($100,000�, IN AODITION TO THE COST OF COMPENSATION, DAMAGES A$ PROVIDED FOR IN SECTION 3JO60F THE LABOR CADE, IMEREST, AND HTTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aflirtn ihat I am lice er provisio s f Chapter 9(commencing with Section 7000) ot Division 3 oi the Business antl Professions Code, antl my license is in full
lorce end eHect Lic. #` �2.2��� Class p. `��Zn
CONSTRUCTION LENDING AGENCY:
❑ I hereby aKrm ihat ihere is a consiruction lending agency for the peAormance of ihe work for which ihis pertnit is issuetl. (Sec. 3097, Civil Cotle).
Lender's Name: Lender's Address:
Signe�ure:
Date:
OWNER-BUILDER DECLARATIONS:
I hereby aHirm that under penalry ot per�ury thet I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Protessions
Code: Any ciry or counry which requires a permit to consiruct, alter, improve, demolish, or repair any structure, prior to its issuance, elso requiras the applicant tor such permit
to file e signed stetement that he or she is licensed pursuant to ihe provisions of the Contrectors License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business end Profassions Code) or that he or she is eaempt theretrom and the basis for the allegetl ezemption. Any violatlon oi Section 7031.5 Dy any applicant for a pertnit
subjects the epplicant to e civil penalry et not more than tive hundred dollars ($500).):
❑ I, as owner ot ihe proparty, or my employees with waqes as iheir sole compensation, WILL DO 7HE WORK, antl Ihe s�ructure is not Intentletl or otfered for sale (Sec.
7044, Business and Protessions Code: The Contractors License Law tloes noI apply lo an owner of pmperty who builds or improves ihereon, antl who dces such work
himself or herselt or through his or her own empioyees, provitled that such improvemenis are not intended or oflered for sale. If, however, tha builtling or improvement is
soltl within one year of completion, the owner-builder will have ihe burden of proving that he or she ditl not build or improve for purposa of sale.).
❑ I, as owner of the properry, em E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to consimct the project (Sec. 7044, Business end Professions
Code: The coniractors License Law does not apply to an owner of property who builtls or improves thereoq and who contrects for such prolect with a contrador(s)
license pursuant to the Comractors License Laws.).
❑ I am axempt under sec. Business antl Piofassions Code for lhis reason:
Signature:
Owner ID verifietl by tlrivefs license.
❑ Ves ❑ No Oriver's License No.
Verifice�ion of Ownership by (rype of tlaument, i.e. - proper�y taz bill or deed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
Date:
Ezpires:
❑ I hereby certity ihat no evcavetion tive (5) or more feet in depih into which e person is required to tlescend, will be made in connection with work euthonzetl by �his
pertnit, and that no building siructure, scattolding, faisework, or demolitlon or tlismantling ihereof, wiil be more ihan thirry-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title 8, Celifornie Admini5irative Code).
❑ As owner-builder, I will nof employ anyone to do work which would require a pertnil irom the Division of Industnal Sefaty, as notetl a6ove, unless such parson hes a
permit lo do such work from ihe division.
Signature: Date:
Division oi Industnal Safery Pertnit Number:
CERTIFlCATE OF COMPLIANCE AND AUTHORVA710N OF ENTAY: I certify under Denalry of perjury tha� I have read this epplication and state that the infortnation given is
correct. I agree b comply wit ell ate la end city ortlinances relating to building consimction, and authorize represantatives of Ihe Clty ot Costa Mesa to enter upon the
above-tlescribed property for i�sp�ion pu�poses. I agree not to occupy or allow occupancy of any huiltling authonzed by this permit until finel inspection.
COOE t• INSPECTIONTYVE
1616 Fizetl System Final Fire Prevention
1266 Pool Spe Final
200 Final Fe-Roof
201 Flnel BIocWReteining Wall
202 Final Fectory Fire Place
203 Finel Sign
204 Final Demolition
Applicant T —
1j�j� IMRIpLS
CppE 1 INSPECTION TYPE
206 Finel Mechanical
208 Finel Plumhing
210 Finel ElectriCal
212 Flnal Flre Prevention
220 Finel Planning Approvel
222 Final Site
250 Final Building/Occupancy
(714) 754-5273 • Fax (774) 754-4836 • www.cl.costa-mese.ce.us 77 FAIR DRIVE, COSTA MESA, CA 92628
MECHANICAL PERMIT
Job Atldress: 361 22ND ST
Suite No
Viciniry: MASTER BEDROOM AND LIVING ROOM
Parcel Number: 42617117
Applicant: DONALb PATfON
Addiess: 1018 NOTTINGHAM RD
NEWPORTBEACH,CA
Phone: 949-644-8696
Zip: 92660
Owner: MITCH�LL, STEPHEN H TR
Address: 361 22ND ST , - -
' - � � � � � Phone:
COSTA MESA, CA Zip: 92627-1800
Contracror: DONALb PATTON CONSTRUCTION INC
Address: 1018 NOTTINGHAM RD
� � � Phone: 949E44-6696
� NEWPORT BEACH, CA 2ip: 92660
License: 521850
Stafus: ISSUEO
Applied: 07/74I2006
Issued: 07114/2006
ISSUED BY:
�I � ,
'/ � : ���
••
SCOPE OF PERMIT
MECHANICAL PERMIT FOR 2,802 SF ADDITION TO SFD (858 SF TO 1 ST FLOOR AND 1944 SF
TO 2ND FLOOR) AND 107 SF ADDITION TO GARAGE. � �,
REF#: BOS-02157 ,
WORK TO INCLUDE: 2 FACTORY FIREPLACES
NO OTHER WORK AUTNORIZED UNDER THIS PERMIT.
ISSUE FEE
Ins� FAU <100 k BTU
Ins� FAU >700 k BTU
Repair/Alt CoolingMeat
Inst / Rep. Recess Wall Htr
Refrig Sys <100 k BTU
Refrig Sys >700 k BTU
Gas Piping
Factory Fireplace
Hood w/Mech Exhaust
VAV Box
Vent Fan / Single Duct
Appliance
Fire Dampers
SmokeDampers
Inst or Relocate Appl Vent
Air Handlers � 10000c(m
AirHandlers> t0000cfm
Floor Furnace
Floor or Suspend Heater
523.50
$0.00
$0.00
50.00
50.00
50.00
$0.00
$0.00
521.30
$0.00
$0.00
$0.00
$0.00
50.00
50.00
so.00-
50.00
50.00
$0.00
$0.00
Ouantity
0
0
0
0
0
0
0
2
0
0
0
0
0
0
0
0- ,
0
0
0
FEE SUMMARY
�' Repair I Alt Absorbtion Unit
.� Repair I Alt Refngeration Unit
Ventillation System
EvapOrative Cooler
Commercial Inci neretor
Domestic Incinerator
� Compressors /AbsorDtion Svstems
Up to 3 hp I 100 k BTU
3To15hp/SOOkBTU
� 5 To 30 hp / 1,000 k BTU
30 To 50 hp / 1,750 k BTU -
Over 50 hp / Over 1,750 BTU
Boilers
Up l0 3 hp
3To15hp
. 15 to 30 hp �
- 30 to 50 hp
Over 50 hp � �
OtherMechanicalFee �
Investigation Fee
� Plan Check Fee
� � Reinspection Fee
Quantity
50.00 0
ao.00 0
50.00 0
50.00 0
so.00 0
so.00. o
50.00 0
50.00 0
50.00 0
50.00 0
so.00 0
SD.00
$0.00
� , � so.00
/�.: � $0.00
50.00
50.00
50.00
50.00
TOTAL CALCULATED FEES §44.80
NOTiCE: The work eNhorized by this permlt shall comply with all appllcable handicap access requirements under
regulations. (Ord. No. 92-28, § 1, 12-21•92) ,.
0
0
0
0
0
and related
EXPIRATION: This partnit shall automaticalty expire end become void if work Is not commenced wlthin 180 days, or If work Is susperWed or ebarWoned
for a perlod of 180 days.
INSPEC710NS: In order for the work aulhorized under this permit to be considered legal, sueh vrork must compty wl�h all epplicable codes, arW all
requlred Inapeetlons end final epprovel must be obtalned. Feilure to obtain Inspections and final approval wiil result in the expiration of this Dermit.
FOR INSPECTIONS CALL: (714) 75¢5828
zus+e (eroo)
WORKERS'COMVENSAnON DECLARAnON: —
I hereby efllrm untler penaly ot per�ury me of the Idlowing tledaretions:
❑ I �eve entl wlll malntein e centliceta of consent to selt-Insure lor workers' compensatlon, as proNded tor by aectlon 3700 of ihe LeEor Cotle, for Ne pertortnance of Ne
work fOr which Ihis permit Is Issuetl.
❑ 1 heve entl wlll maintain workers' compensatlon Insurence, as reQulretl by eectlon 3700 01 Ihe Lebor Catle, tar the pertortnence oi Ihe wark Iw whlc� UJs peimlt ls Ls.wed, -
My workers' compensatlon Insurance carrler entl pollcy number ere:
Certler: S%.�1%� FUN/J PoIlqNumber. o4(v - aoo9470
(Th/5 sectlon need not be rompleted I/ Ihe pertnit b velued ef one huntlred dd/ers (5100) or IeSgJ
❑� I ceNy t�et In t�e pe ence of Ue work for whicli ihis pertnit U IssueQ I ahell not employ any peroon In eny menner eo es to Eecome euD�ect lo the workera'
compensatlon lews 1 Illomla,/ n agroe the I ah Itl becane sub�ect to Ne workero' compensetlon provLalons ot Secllon 3700 of Ne Labor Cotla, I shall foMwlth
compty with �hese �loa� /
Applicent Sipneture: � l�L'O.I.GT �// G� oa,a: 71�q lo �
WARNINO: FAILURE TO SECURE WORKERS' COMPENSATION ODVERA(iE IS UNLAW R1L AND SWLLL SU9IECT Ml EMPLOVER TO CRIA9NAL�WLL ES �ND CMl FlNES UP TO ONE HUNDRED
TIqUSAND DOl1ARE (Et00,000�.IN ADORION TOTHE CO^.aT OF COMPEMSATION, DMUOES 0.S PiqV10ED PoR IN SEGfION 3'!OB OF THE LABOfi CODE, INTEREST, M!D �TTOHNEYS FEES.
LICENSED COMAACTORS DECLARATION:
1 hereby afllrtn t�al I ert
larce end eMect. Lic. M
Contractors slpnacure:
Chapter B(commendng with Sectlon 7000) of Divlslan 3 af t�e Busin sa end Professlons CaAe, erW my Iicense Is In full
Claee N
_ Date: 7 O(o
CONS7RUCTION LENDINO A�ENCV:
❑ I �ereby eMirtn thel there is e conslrudion lerrclirig epericy for the peAormence ol Ihe woB lor which this portnil Is issued. (Sec. 3097, Clvil Code).
Lentlers Name: Lendefs Adtlreu:
Slpnature: Dete:
OWNER-BUILDER DECLARATONS:
I �ereCy ettirtn t�et untler penalry o1 per�ury Ihet I em EICEMPT FROM TNE CONTRACTORS LICENSE LAW ior Ihe fdlowing reason (Sec. 7031.5. Business end Professions
Cade: My dry or counry whicl� requlres e permtl to constnut, elter, Improve, Cemdis�, a repalr eny structure, prlw ro Ils isauar�ce, flL90 requlres Ne epplicant lor such pertnit
to tile e signeC stetement Net he or ahe Is Iicensetl pursuent to Ihe provlsbns of Ne Contrectom License Lew (Chepter 9(cammendnp wlth SecUon 7000) of DMsion 3 oi the
Business antl ProteSsions Cotle) or Ihet he or ahe Is exempt Iherefrom ena Iha basLa far Ne ellegeE exemptlon, My Ndetlon of Secllon 7031.5 by eny epplicent iw e pertnit
sub�ects Ne appllcant to e dvll penelry of not more ihan flve hunEretl OWlera (E500).):
❑ I, es owner o1 the properry, or my empiqrees wlth wepes as Nelr ede compenseUon, WILL DO THE WORK, end �ha swaure b not IntenOeC or oflered tor sale (Sec.
7004, Business entl Protesslons Code: The ConVaclors LJcense Lew Ooes not epply to an owner ot properry w�o bullds or improves Ihereon, antl who tloe9 Such work
himsell ar heneN or through his or her own emplqrees, provitletl Nat such Improvements are not Intended or otlered for sale. If, however, the DuilCing or improvement la
sold within one year of completlon, the owner-builtler will have Ne burden of prMng thet �e or s�e dIE not build or Improve for purpose o1 sale.). '
❑ I, es owner o1 Ne properry, em E%CLUSIVELY CONTAACTING WITH LICENSED CONTRACTORS lo construct the pro�ect (Sec. 7004, Bwiness arW Profeaslorw
CoOe: The contractors License Lew does rwt epply to en owner o1 property who builtls or Improves Nereon, end who conlracls for such pro�ect wiN a coniraqor(s)
Ilcense pursuant to the Conlradora License Lews.j.
❑ I am exempt unCer sec.
Signeture:
Owner ID verifed by dr'rvers Iicense. ❑ Yes ❑ No
Business end PrWessions Coae for Ihis reason:
Vediicatlon of Ownershlp by (type of tlocumem, I.e. - properry ten bill or dead):
DrNeYa Llcense No.
Date:
Expires:
DIVISION OF INDUSTRIAL SAFETY VEflMIT CERTIFlCATION:
❑ I hereby certily that no excevetion tive (5) or more leet In depth into which a{rerson Is requlred to Gescen4 wlll be metle In connectlon wlth work euthorizetl by thls
pertnit, end t�at no Duiltlinp siruclure, scettddinp, lalsework, or demdltion or dismentling Ihereol, wlll be more �hen Ihirty-six (38) leet hig�. (C�ep. 3.2, drp 2, M 2, Sec.
341, Ttle B, Celifomla AdminislreUve Code).
❑ Ae owner-builder, 1 wlll not employ enyone to da work which would raquire e permlt Irom Ihe DlWelon ol IndustAel Sefery, es noteO above, unleas euch peroon hea e
permil to do such work trom the tllWsion.
SlgneNre: Date:
Divislon ot Industrial Selery Permil Number:
CEH7IFlCATE OF COMPLIANCE AND AUTHOR¢AT10N OF EMRY: I ceNty under penelry of per�ury t�a� I heve read Ihis epplicetlan end state Nat the InlortneGon pHen b
correct I egree to compy with ell stete laws end dry orAinences relating to Eu1lClnp construnion, end euthodze representetNes of Ne Ciy at Coste Mesa to enter upon the
ebove-describetl property tor InsOectbn purposes. I epree not to occupy or ellow occupency of eny Duiltlinp euthorized by Ihis permi� until Onel InspecUon.
gnQttyeO elOwner(s) ?// � /_et�
J�� � % //l7� _rF s 1
And/�rAut�onze 0����� Date
GODE �. �xsvecraNrrre
1616 FIxeC System Flnal Fire Praventlon
7268 Pool Spe Final
200 Flnal Re-Rool
201 Flnel BIacWRetalning Well
202 Finel Fattory Fire Place
203
204
Finel Slgn
Finel Demolitbn
QAg Q�ELB
� ixsveerroxme
20B Finel Medianicel
20B Finel Plumbing
270 Finel ElectriCal
212 Finel Flre Preventlon
220 Finel Planning Approvel
222 Finel Sice
250 Finel Bulldinp/Occupenq
� ��
(714) 754-5273 • Fa�c (714) 754-4056 • www.ci.costa-mesa.c�ILDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 361 22ND ST
Suite:
Vicinity: 2 FLOOR
PrimaryOcc: R3/Ui
Parcel Number: 42617117
Appliwnt: HAWTHORNE, ELIZABETH
Address: 2900 BRISTOL STRET
COSTA MESA, CA , , �
owner: MITCHELL, STEPFIEN H TR
Type of Construction: V-N
Zoning:
Phone: 949-975-Ot23
-�- Zip: -92626 .. .
Address 361 22ND ST . ' �
- � - Phone: �'
COSTA MESA, CA � � Zip:
��� ._.. . . - .. ...
Contractor: � DONALD PATTON CONSTRUCTION INC
Address: 1018 NOTTINGHAM`RD
Phone:
Arch :
Address:
Z�P
NEWPORT BEACH, CA
Zip: • 92660::.��'
Phone:
� ` �. License: -
Status: PC
Applied: 11/29/2005
Issued:
ISSUED BY:
9262Y;8�� � � ,� � I.�IRED
.67.
DA'fE �
949.644.8696
.License: 521850
Eng: SHUCRI YAGHI
Address: 112 E CHAPMAN AV
SUITE D
ORANGE,CA
92866
Phone: 714-997-9120
License: C43205
SCOPE OF PERMIT
'2,802 SF ADDITION�TO SFD (858 SF TO 1 ST FLOOR AND 1944 SF TO 2ND FLOOR) AND 107 SF ADDITION TO�GARAGE. WORK TO ALSO INCLUD
2ND FLOOR DECKS; COMFLETE REMODEL OF 1ST FLOOR; CONVERT 80SF OF 3 CAR GARAGE TO STORAGE AREA AND 2 FIRE PLACES, t IN
ROOM AND MASTER BEDROOM (ER 5677). � - .. �
- . , _ : -.>--.. . . . , . , .
EXISTING 3 BEDROOM, 2 BATHROOM SFD TO BE CONVERTED INTO A 5 BEDROOM, 5 FULL BATHROOM AND 2 HALF BATHS SFD.
GUESTHOUSE AT REAR OF PROPERTY APPROVED UNDER COUNTY JURISDICTION. NO KITCHEN ALLOWED IN GUESTHOUSE. NO �
CHANGES TO GUESTHOUSE UNDER THIS PERMIT. � ��
u.- ,__..
Plan Check: :- $1,737.94 `
Permit: $2,673.75
� SMIP Res:, � �$40.00
SMIP Com: $0.00
FEE SUMMARY
Calc Valuation: $aoo,000.00
Claim Valuation: Saoo,000.00
Other: $0.00 � ' �
Inspection: .. $0.00 `
Total: $4,451.69
PLANNING & ZONING
SETBACKS' „
MAINSTRUCTURE Front 0-0 " .�.,Rear '0-0 Left 0-0 Right 0-0 �
ACCESSORY Front - 0-0 �� •'Rear -0-0 �� Lefl- "0-0�'� . Right 0-0
PARKING Existina: 0 .Reauired: 0 Pronosed: 0
NOTICE: The work aulhorized by this permit shall comply with all applicable handicap access requirements undar Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 72-21•92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned
tor a period of 18o days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred inspections entl finel approval must be oblained. Fallure to obtain inspections and tinal approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5826
zaeae �aroo�
WORKERS'COMPENSAnON DECLARAnON: � � .� - ' .
I hereby aHirtn under penalry`of perjury one of Ihe following tlederations: � ' � r ;
❑ have antl villl malntain a certlficate ol consent to setl-Insure tor workers' compensation, es provided for�by seclion 3700 of the Lebor Code, for the pedormanca oi the
work tor which this permit Is issuetl.
I have and will malntain workers' compensation insurance, as requiretl by sec�ion 3700 of �he Labor Cotle, Por the pertortnance of Ihe work br which this pertnit is issuetl.
My wgrkars' compensation ICnsurance cartier antl policy number ere: . �
Cerrier.JlJ%��1%� / ��iUn , POlicy�Numbar:_i7i�99%(�- 2b��0
(Th/s section neetl not be comp/eted i/ the permit is velued af one hundretl tlollars ($100J or less.) . .
❑ I certity that in the perto nce of the work tor which ihis peprt�nit is issueQ 1 shall not employ any person in eny manner so as to become subject to the workers'
com� � sation law � 1 el' ornia, an egr,ee th� f I sryquli/tl pBpome subject to the workars' compensation provislons of Saction 3700 of the Labor Code, I shell forthwith
com I9withihese r si �/�d// I/ /L r
// r7n.
�pliceniSineture�l � I/. /// ,cirr, �.�.=oa��'�� /2 29�/�S
WARNING FAILURE TO SECURE WORKERS' CAMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUflIECT AN EMPLOVER TO CRIMINNL P NALTIE AND CIVIL FINES UP TOONE HUNDRED
THOUSAND OIX.IARE (E100,000). IN ADDITION TOTHE C0.ST OF COMPENSATIIXJ, DAMAGES AS PROVIDED WR IN SECTION 3]O60F THE IABOR CO�E, II�frEREST, AND AiTORNE`fS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aflirm that I am licensed untlerQrovisic
CONSTAUCTION LENDING AGENCV:
of Chapter 9(commencing with Section 7000) of Division 3 of the Business end Professions Cotle, antl my license Is in tull
❑ I hareby eNirm thal Ihere is e constmction lentling agancy tor the peAormanco of ihe work for which this pertnit is issued. (Sec. 3097, Civil Code).
Lendefs Name: Lendefs Address:
Signature:
OWNER-BUILDER DECLARATIONS:
Date:
I hereby aHirtn ihat under penalty af perjury thet I am EXEMPT FROM THE CONTHAC70RS LICENSE LAW for the tollawing reasan (Sec. 7031.5, Buslness end Pratessions
Code: Any City or County which requires a pBrmit to cOnstmct, alter, improve, demolish, or repair any structure, prior to its i55uance, also requires the applicant for SUCh pertnit
m file e signetl statement that he or she is Iicensea pursuant ro the pmvisions of the Contractors License Lew (Chapter 9(commancing with Section 7000) of Divislon 3 of the
Business and Professions Code) or that he or she is exempt Iheretrom and Ihe basis for the allegetl exemption. Any violetion of Section 7031.5 by any aOP�iwnt for e pertnit
subjects the aOPlicant to e civil penalry of not more than tive hundred dollars ($500).):
❑ I, es owner ot Ihe property, or my employees with wages as their sole compensation, WILL DO THE WORK, end the structure is not intended or oHeretl far sale (Sec.
7044, Business and Professions Code: The Coniractors License Law does not apply to an owner of property who builOs or improves ihereon, and who does such work
himself or herself or through his or her own employaes, pmvidetl that such Improvemenis ere not intended or ottered lor sale. If, however, ihe building or improvement Is
sold within one year of compietion, the owner-builder will heve tha burden of proving t�at he or she did not buiid or improve for purpose ot sele.). •
❑ I, as owner of the pmperty, em E%CLUSIVELY CONTRACTING WI7H LICENSED CONTRACTORS to constmct ihe proiect (Sec. 70a4, Business entl Professions
Code: The contrectors License Law Does not apply to an owner oi property who builds or Improves Ihereon, and who coniracts for such projacl with e coniractor(s)
license pursuant to the Comracbrs License Laws.).
❑ I am exempt undar sec. Business and Protessions Cotle for this reason:
SignaWre: Date:
Owner ID verilied by drivefs liCense. ❑ Yes ❑ No Drivers License No.
Veritication of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
Ezpires:
❑ I hereby certify thet no exwvetion tive (5) or more Feet in depth into which a person is requirad to descend, will be made in connection with work euthonzed by ihis
pertnit, antl that no Duiltling siructure, scaHolding, falsework, or demolition or dismantling thereot, will be more ihan ihirry-six (36) feet high. (Chap. 32, Grp 2, Ar12, Sec.
341, Title B, Calitomia Adminisirative Cotle).
❑ As owner-builder, I will not employ enyone to tlo work which would require e permit fmm the Division of Industrial Sefary, es noted ebove, unless such pereon hes e
permit to tlo such work fram the division.
Signeture: Dale:
Division ot InduSinal Safery Pertnit Number:
CERTIFICATE OF COMPUANCE AND AUTHOHIZATON OF ENTRY: I certify under penalty of perjury that I have read �his epplica�ion entl state that the infortnetlon given is
correct I egree to wmply with all stete laws and ciry ordinances rela�ing to building consiruction, and euthonze represeniatives ot �he City ot Costa Mesa to enter upon Ihe
above-descnbetl propeny for inspection purposes. I agree not to occupy or ellow occupancy ol eny building authorized by this pertnit until finel inspection.
1 JSgnel f Owne}(s)
ILL
'AnNOr AuthorizedrAppllcem
COOE t. INSPECTIONTYPE
1616 Fixetl System Final Fire Prevention
1266 Pool Spa Final
200 Final Fe-Roof
201 _Final Block/Retaining Well
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition �
UATE j�$
COpEt INSPECTIONTYPE
206 Finel Mechanical
208 Final Plumbing _
210 Final Elecirical
212 Final Fire Prevention
220 � Final Planning Approval
222 Flnal Slte .
250 --Finaleuiltling/Occupency�
� ateq /��
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NEWPORT-MESA UNIFIED SCHOOL DISTRICT
CERTIFICATE OF COMPLIANCE Of DEVELOPMENT FEES
PURSUANT TO AB 1600 ANO AB 187
To: ( Cily of Costa Mesa
City of Newport Beach
( ) Counry of Orange
(�� —�� 5689
DisUict Receipt No��
Plan Check No. �S—(72 �
APPrcant � TF f� !�F N M► T C�� L�
Address: �� �7 n/ 57 �CJ S�% M fJq �/�1 pj 26 2�
Telephone Number. �% � 9— ��/ r% 70 ��
TracUParcel and Lot Number(s): � Z o— �7� �7
Location of Project:
Number of Square Feet of:
Residential Space
Commercial and
Industrial Space
CommerciaUlndustrial Projed is: (Check One)
Warehouse
R8D
Movie Theater
Mini-storage
Heavy Industrial
Regional Shops
Light Industrial
_ This project is exempt because
$�%2 x31.84
xS.30
_ Motel
Bank
_ Neighborhood Shops
_ RacqueUHealth
_ Hotel
_ MedicalOffice
_ O(fice Park
To�� ��5.5 �8�
Total
Preschool
Auto Repair
Hospital
Large O(fice
Ofice Bldg.
Restaurant
Fast Food
This certifies that the above-named Developer/Applicant has paid school faci,lily fees in comp6ance with Government Code sections
53080 and 65995. The Building Permi� (or this square footage in this proposed devebpment may now be issued by your jurisdicBa�.
Checks are to be made payable to Newport-Mesa Unified School Dishict.
�-.ha�l�
AWaraad RepreseMative
The above representaUon as to square (ootage is We. AppBcant agrees that if k is later determined that such representations are not
true, then this certificate shall automaticaly terminate and the appropriate Cily/County shall be notified.
Date: IZ 2 � ��
11/17/2006 10:01 714-7 i76
11I17/2006 10:Oi 1714•i �46i
S YAGHI ENGINEF^� G PAGE 01
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MITCHELL REMODEL
361 22ND STREET
COSTA MESA, CA 92627
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Job Ac
Name
Residence Address
Number & Street
, ,�'Y OF COSTA MESA, BUIIDWG DIVISI �
SPECIAL INSPECTOR REGISTRATION
Laborato
Address
r�n, c.��e 7..
street ciry Zip
All ticenses listed below must be currently valid and legible copy(s) and must be atlached to this registration.
DISCIPLINE L.A. COUNTY L.A. CITY ORANGE COUNTY OTHER
Concrete (� � ��" �
Ductile Moment Resisting Frame
Reinbrcing Steel, Prestressing Steel
Welding
High Sirengih Bolting .
Strudural Masonry
Reinforced Gypsum Concrete
Insulating Concrete Fill
Sprayed on Fire Proofing
Pilings, Drilled Piers, Caissons
Special Grading, Exravation or Filling
Special Cases Unusual Hazards
I hereby ceRify that i am qualified by training and experience to perform the inspections for which I hold the above listed Special
Inspectors licenses, and will provide all certificalions required by [he Ciry of Costa Mesa.
I will inspect and certify the following
I will certiry not only to the job conditions but that they are in conformance with the approved plans. If at any time, progress occurs
on the above mentioned job relating to my area(s) of responsibility, without my knowledge or approval, I will stop the jobs prxess
immediately with notification in writing to the job superintendent and notify the Building Division of the situation. A record of my tests and/or
inspections as agreed to above will be available upon request by ihe Building Division. Upon submit a complete package of
testing and inspection results. A letter certifying satisfactory completion will be pro�ided by e upon complet�on.
�'�-a7
Date
The registration is accepted and approved by:
1068-46 (re¢ 2/02� W hile- Builtling Division: Canary - Special InsOecloc Pmk - Developer
,, .
Joint Certified
ICBO Reinforced Concrete
ACI Concrete Field Tech
5art� �. �orion �
Special lnspection Services
6232 Kiowa Road • Westminster, CA 92683
Ph 714-895-1344
Fa�c714-899-5684
Mobile 714-309-7304
CONTINUED ON NEXT PAGE � PAGE OF�
TIME IN 71ME OUT REG. HOURS O.T. NOURS SAMPLES
� All inspections basetl on a mi ' em�pl-4.hours antl over 4 hours - 8 hour
minimum. �
ISTERED I SPEC
7�� �`-t Mcroveeey
NO AGENCY ' r tentlent
WHITE - CITV'S COPY CANARV - ACCOLINTWG COPV. PWK - INSPECTOR'S COPY